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    The Influence of Leadership Competencies on Sustainable Funding of Local Non-Governmental Organizations in Uganda
    (Journal of Public Administration and Governance, 2017-09-08) Kyalimpa, Paul; Asiimwe, John Baptist; Netswera, Fulufhelo Godfrey; Rankhumise, Edward Malatse
    When a leader with a vision launches a Local Non-Governmental Organization (LNGO or NGO), the NGO’s motivation and decision-making often become intertwined with the leader’s personality and character to the effect that it may collapse when the NGO leader departs. Uganda has a higher percentage of NGOs inactivity and mortality due to unsustainable funding. Therefore, this study investigated the influence of NGO leadership competencies on sustainable funding of NGOs. This study utilized a descriptive correlation design. A proportionate stratified sample of 103 NGOs was obtained and their leaders were interviewed using self-administered questionnaires. Records reviews were conducted to obtain data on NGO funding. This study found a 90.1% to 100% agreement by participants on possession of the various leadership competencies by the NGO leaders. A marked rise in incomes from all sources was recorded between 2010 and 2014, with external donors, local donors, and own income accounting for 67%, 13.5%, and 19.5% of the total funds, respectively. The average donor-dependency ratio and survival ratio over the 5 year period was 80.54% and 71.216 days respectively. The NGO leader/CEO understanding and working with whatever resources that are available (β=-9.802, P=.002) and spearheading the implementation of major investment decisions (β=15.720, P=.004) were the only competencies found to be statistically significant predictors of NGO financial sustainability. Recommendations. Government funding of NGOs, prioritization of Income Generating Activities and capacity building of NGO leaders in effective and efficient resource utilization and investment by NGOs, are key to NGO Survival.
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    A Model for Enhancing Digital Transformation through Technology‑related Continuing Professional Development Activities in Academic Libraries in Context
    (Discover Education, 2024-07-02) Nakaziba, Sarah; Ngulube, Patrick
    This paper is based on the findings of a doctoral study that aimed to examine the role of continuing professional development (CPD) in enhancing digital transformation in selected university libraries in Uganda. One of the ways of effecting digital transformation is to continuously build the technological competencies of the librarians working in academic institutions through attending technology-related CPD. The study adopted a mixed methods approach with a convergent parallel design for collecting qualitative and quantitative data from six universities in Uganda. Quantitative data were collected from 76 librarians with a minimum degree-level qualification from the six selected universities. Qualitative data were obtained from six University Librarians working in these universities. The study findings indicated several challenges hindering librarians from participating in technology-related CPDs such as lack of management support, lack of personal interest, limited funding, and lack of opportunities, among others. The implementation of digital transformation within university libraries in Uganda was also reported to be beset by a lack of competent staff, limited management support, lack of funds, and technological gaps. Therefore, this paper presents a proposed model to address challenges hindering the digital transformation and the participation in technology-related continuing professional development activities within academic libraries. The proposed model is based on the study findings, and it draws from Watkin and Marsick’s learning organisation model, andragogy theory, the technology-organisation-environment framework, and extant literature. The model will guide academic libraries in the implementation of a conducive environment to necessitate staff development and implementation of digital transformation.
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    Credit and Sustainability of SMEs in Uganda: A Case of SMEs in Nakawa Division Kampala
    (Journal of Economics, Finance and Accounting Studies, 2022-12-03) Muhire, Francis; Olyanga, Anthony
    The study was carried out to establish the relationship between Credit terms, Credit accessibility, and Sustainability of Small and Medium Enterprises in Uganda. The objectives guided the study to examine: the sustainability of SMEs, the level of credit accessibility by SMEs, the credit terms by financial institutions, and the combined impact of credit terms and credit accessibility on the sustainability of SMEs in the Nakawa Division. The study was based on a cross-sectional research design and quantitative research approach of 743 registered SMEs in the Nakawa Division and a sample of 248 SMEs. Primary data was collected using questionnaires. Data from the field was compiled, sorted, and edited for analysis using SPSS. The results indicated significant positive relationships between credit terms and sustainability, credit accessibility and sustainability, and credit terms and credit accessibility of SMEs within the Nakawa Division. Based on the findings, the study recommended that financial Institutions need to relax credit terms which will increase credit accessibility which also automatically lead to sustainability; SMEs should ensure mechanisms that can boost their credit accessibility, and the government should put in place policies that ensure easy access to credit by SMEs and should further increase funding and come up with more entrepreneurship oriented programs such as capital ventures which well maximized guarantee sustainability of SMEs.
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    External challenges of development studies programmes in contributing to the development of Uganda.
    (Ideal Journal of Education and Policy Studies, 2015-08-23) Lubaale, Grace
    This study which ventures into the Challenges of Development Studies Programmes (DSP) in Contributing to the Development of Uganda attempted to unravel and establish the specific challenges of Development Studies Programmes offered at Uganda Martyrs University (UMU) and Makerere University Kampala (MUK). Both qualitative and quantitative approaches were employed so as to provide the necessary triangulation for getting a more composite data to articulate better the findings. Further, a descriptive research design specifically a case study was adopted in order to secure in-depth data regarding challenges of DSP offered at UMU and MUK in contributing to the development of Uganda. The study used a sample size of 260 respondents using research instruments of a semi-structured questionnaire, interview guide, and check list. The study established challenges as; Unemployment, corruption, poverty, working environments, professional body, gender and young age of graduates and finally government policies. To overcome the aforementioned challenges, the study recommends quality teaching, think tank, policy formulation and forming a professional body. It is hoped that if implemented, DSP will be able to contribute a great deal to the development process of Uganda.
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    Gender Imbalances among Students in Kyambogo University of Uganda and Development Implications
    (Online Submission, 2020-01-28) Lubaale, Grace
    Kyambogo University (KyU) is one of the nine government universities in Uganda experiencing gender inequalities with glaring development implications in the country with 34.6 million people (UBOS, 2016) in which women are the majority. The central aim of the paper is to establish the gender imbalances in Kyambogo University and development implications with a specific focus on policies, facilities, and services for students and then provide the way forward. This study used a mixed-methods approach that combined desk reviews and interviews (Creswell et al., 2017). The findings indicate that nature is reflected in the admissions, completion, science and engineering programmes and student leadership while the development implications are colossal in terms of imbalances in Kyambogo University dropouts, Student Leadership, Higher Degree Achievements, returns to education, and lose of Self-Esteem. In conclusion, it is now clear that gender imbalances in KyU is a reality and this paper recommends promoting gender equality by all stakeholders majorly through the KyU Gender Mainstreaming Directorate, and through the establishment and operationalization of KyU Gender Policy, Anti-Gender Violence Policy, Gender Responsive Budgeting, STEM Programme, and Gender Monitoring and Evaluation.
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    Domestic Violence and Development Implications in Budaka District
    (EUREKA: Social and Humanities, 2022-09-30) Lubaale, Grace
    Budaka is one of the 146 districts in Uganda experiencing domestic violence (DV) with 5016 cases, recorded in 2020. This was a significant number with obvious development repercussions despite relevant regulations, prohibiting the vice. The purpose of this study is to determine the nature and causes of domestic violence in Budaka district, development implications, and then suggest a course of action. A mixed-methods approach that included desk review and interviews to obtain quantitative and qualitative data, respectively was used. Domestic violence affects people of all ages, education levels, income levels, social standing, and religions, and manifests itself in form of physical, economic, sexual, political, religious, cultural and psychological. Poverty, culture, ethical and moral failure, biological vulnerability of women, and difficulties in obtaining evidence are the causes of domestic violence with far-reaching economic, political, and social development implications in Budaka district. In conclusion, domestic violence exists in Budaka district as a social construct with enormous developmental ramifications. The study recommends deconstruction through adopting Uganda's National Gender Policy of 2007, gender mainstreaming in the district, enacting by-laws, gender monitoring and evaluation, and strengthening Mifuni NGO in the fight against domestic violence
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    Gender Imbalance in Science Disciplines at Kyambogo University of Uganda and Development Implications
    (Journal of Science and Sustainable Development, 2022-03-18) Lubaale, Grace
    Kyambogo University (KyU) is one of Uganda’s nine public universities. Like any other University, KyU is experiencing gender imbalance in science disciplines. This comes with glaring development implications in a country of 34.6 million people, women being the majority. This paper presents results from the study that focused on the nature of gender imbalance in science disciplines at KyU; its causes, development implications, and possible remedies. The study followed a mixed methods approach that combined desk review and in-depth interviews. Documents reviewed produced quantitative data using the checklist while in-depth interviews generated qualitative data that was collected through face-to-face interaction with 42 respondents. Quantitative data was analysed using descriptive statistics while qualitative data was analysed through content analysis. Findings indicate that the nature of gender imbalance in science disciplines is reflected in the admissions and completion; while causes are patriarchy, gender stereotypes, and limited mentorship. The development implications on women and society are in terms of low enrolments, self-esteem, academic staff recruitment, and education returns. The study concludes that gender imbalance in science disciplines at KyU is a reality, socially constructed, and can be deconstructed. In order to enhance gender balance in science disciplines, this study recommends creating science awareness in primary and secondary schools, providing scholarships for females to offer sciences at university, affirmative action through STEM Programme, empower the people at KyU to explore the Gender policy and strengthening the Gender Mainstreaming Directorate while ensuring appropriate gender monitoring and evaluation processes.
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    Gender imbalances in science disciplines among students in Kyambogo University of Uganda and education implications
    (Lwati: A Journal of Contemporary Research,, 2021-10-04)
    Kyambogo University (KyU) is one of the nine government universities in Uganda experiencing gender inequalities in science disciplines with glaring education implications in country with 34.6 million people in which women are the majority. The central aim of the paper is to establish the science gender imbalances in KyU and education implications with a specific focus on policies and practices for students and then provide the way forward. This study used a mixed methods approach that combined desk review and interviews. The findings indicate that the nature is reflected in the Admissions, and Completion, and the causes are patriarchy, gender stereotypes and roles and mentoring while the education implications are colossal in terms of low enrolments, self-esteem, academic staff recruitment and education returns as well as low Higher Degree Achievements. The study concludes that science gender imbalances in KyU is a reality, socially constructed and can be deconstructed. Therefore this paper recommends creating science awareness in schools, providing scholarships for females, affirmative action through STEM Programme, strengthen the KyU Gender policy and Gender Mainstreaming Directorate, and Gender Monitoring & Evaluation which will lead to gender equality in sciences disciplines.
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    Domestic Violence and Development Implications in Budaka District
    (EUREKA: Social and Humanities, 2022-09-30) Lubaale, Grace
    Budaka is one of the 146 districts in Uganda experiencing domestic violence (DV) with 5016 cases, recorded in 2020. This was a significant number with obvious development repercussions despite relevant regulations, prohibiting the vice. The purpose of this study is to determine the nature and causes of domestic violence in Budaka district, development implications, and then suggest a course of action. A mixed-methods approach that included desk review and interviews to obtain quantitative and qualitative data, respectively was used. Domestic violence affects people of all ages, education levels, income levels, social standing, and religions, and manifests itself in form of physical, economic, sexual, political, religious, cultural and psychological. Poverty, culture, ethical and moral failure, biological vulnerability of women, and difficulties in obtaining evidence are the causes of domestic violence with far-reaching economic, political, and social development implications in Budaka district. In conclusion, domestic violence exists in Budaka district as a social construct with enormous developmental ramifications. The study recommends deconstruction through adopting Uganda's National Gender Policy of 2007, gender mainstreaming in the district, enacting by-laws, gender monitoring and evaluation, and strengthening Mifuni NGO in the fight against domestic violence
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    The Relationship Between Young Children’s Influence and violence against children in Selected Bugiri Primary Schools in Uganda
    (East African Journal of Education Studies, 2024-04-19) Achan, Jackline Bwire; Maani, John Samson; Lubaale, Grace
    This study investigated the relationship between children's influence and violence against children in selected Bugiri schools based on the fact that Bugiri district had reported high rates of violence against children. The study was guided by the following three research objectives: To establish the level of children’s influence in the chosen schools, determining the level of violence against children at the chosen schools, and lastly to determine the relationship between the two factors (children’s influence and violence against children) at the chosen schools. The study used a sequential explanatory mixed method design and was carried out at two government-aided primary schools in the Bugiri district of Uganda. Two hundred thirty-six (236) young children in primary three comprised the sample, out of the 365 children in the accessible population. The data were analysed using regression analysis and Pearson's correlation coefficient index. The results indicated a statistically significant, correlation between children influence and violence against children in schools (self-esteem, role model attachment and decision-making capacity). The study recommends that children should be used to influence violence decisions and planning at school. Programs at school meant to lessen violence have to include children in choosing violence reduction strategies and implementing violence-reduction activities in schools
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    Influence of School Environment on Physics Teacher Effectiveness in Kigezi Sub-Region, Uganda
    (East African Journal of Education Studies, 2024-01-12) Tukamuhabwa, Evaristo; Kishabale,Bashir; Lubaale, Grace
    This study investigated the influence of school environment on physics teacher effectiveness in secondary schools in Kigezi Sub-region, Uganda. The focus of the study was to establish the influence of administrative support on physics teacher effectiveness; to establish the influence of collegiality of teachers on physics teacher effectiveness and to find out the influence of professional development like workshops, seminars on physics teacher effectiveness. This study employed both quantitative and qualitative techniques to collect and sequentially analyse the data. The study adopted a mixed research design on a sample of 234 physics teachers, fourteen (14) head teachers and six (06) education officials. Data were collected using a self-administered questionnaire, interview guide, focus group discussions and classroom environment checklist. Quantitative data was analysed through the statistical software programs SPSS and SPSS AMOS while qualitative data was analysed using content analysis and verbatim quotations. Descriptive analysis showed that the school environment highly influences physics teacher effectiveness in all aspects. The results of structural equation model (SEM) showed that the school environment influences teacher effectiveness. The findings showed that the school environment as conceptualised as administrative support, collegiality and professional development had a strong positive influence on teacher effectiveness. It was concluded that teachers should create appropriate environment to present new thoughts by creating standards of administrative support, exercise companionship and cooperation between colleagues. Finally, develop professionally and remain relevant with current skills by participating in activities like educational seminars, workshops, and conferences
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    Benefits of ICT in Education: Teaching-Learning Process
    (African Journal of Education, Science and Technology, 2021-08-01) Lubaale, Grace
    The use of Information Communications Technology (ICT) in education and training is increasingly becoming a priority in African countries including Uganda. The paper aims at examining the benefits of ICT in education with a specific focus on teaching-learning process. The presenter used both qualitative and quantitative approaches of identifying the uses, application, relevance and impact of ICT in the teaching-learning process with specific cases in Uganda. The paper identifies and explains benefits of ICT in general and in the teaching –learning process in particular like to the learners in terms of general, motivational, independent learning and team work as well as teachers in planning and preparation. The paper identifies the barriers of ICT use as at five levels; political economy, technology, teachers, school and education system. The paper concludes that ICT is important in the teaching-learning process because it greatly enhances comprehension of the language and subject matter of learners as well as easing the work of teachers. It recommends government, education systems, learning institutions and individuals to embrace ICT holistically.
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    SESEMAT Pedagogical Approaches and Physics Teacher Effectiveness in Kigezi Sub-Region, Uganda
    (Journal of Research in Education and Technology, 2024-01-27) Tukamuhabwa,Evaristo; Kishabale, Bashir; Lubaale, Grace
    Effective physics teachers in secondary schools in Kigezi Sub-Region are a focus to improve the scientific skills, competences and students’ academic knowledge to the required content. There are however, increasing concerns among stake holders about teacher ineffectiveness which has caused dismal performance of students in science subjects particularly physics. The study investigated the influence of Secondary Science and Mathematics Teachers (SESEMAT) pedagogical approaches on physics teacher effectiveness in secondary schools in Kigezi Sub Region, Uganda. Guided by Cognitive Constructivist theory, the study adopts a perspective that views learning as an active process, where contexts of learners are fully considered and learners being motivated and then collaborative learning takes place. Out of a population of 620, a sample of 234 Physics teachers was drawn from secondary schools of Kigezi Sub- Region. Data collection tool comprised of a questionnaire. Collected data was analysed descriptively using statistical software programs SPSS and SPSS AMOS. The findings showed that physics teacher effectiveness is highly influenced by SESEMAT pedagogical approaches in all aspects. The analysis results of structural equation model (SEM)/path analysis showed that SESEMAT pedagogical approaches influenced teacher effectiveness. Hence the causal relationship between SESEMAT pedagogical approaches and teacher effectiveness was positive and significant. The tested hypotheses state that there is a significant influence of SESEMAT pedagogical approaches on physics teacher effectiveness. It was concluded that SESEMAT Pedagogical approaches (active learning, motivation of students, contextual learning, and collaborative learning) are important to physics teacher effectiveness. Therefore, it was recommended that Physics teachers in Kigezi Sub-Region should apply SESEMAT pedagogical approaches while teaching in a good environment for better performance of learners and skills acquisition.
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    Self Help Plus: Study Protocol for a Clusterrandomised Controlled Trial of Guided Self-Help with South Sudanese Refugee Women in Uganda
    (Global Mental Health, 2018-05-30) F. L. Brown, K. Carswell, Adaku A., Leku M. R, P. Ventevogel, R. A. Bryant, M. van Ommeren, W. A. Tol
    Exposure to armed conflict and forced displacement constitute significant risks for mental health. Existing evidence-based psychological interventions have limitations for scaling-up in low-resource humanitarian settings. The WHO has developed a guided self-help intervention, Self Help Plus (SH+), which is brief, implemented by non-specialists, and designed to be delivered to people with and without specific mental disorders. This paper outlines the study protocol for an evaluation of the SH+ intervention in northern Uganda, with South Sudanese refugee women.
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    Guided Self-Help to Reduce Psychological Distress in South Sudanese Female Refugees in Uganda: A Cluster Randomised Trial
    (Lancet Glob Health, 2020-02-14) Tol A. Wietse, , Leku R. Marx, Lakin P. Daniel, Adaku Alex, Mark van Ommeren
    Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees.
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    Self-Help Plus for Refugees and Asylum Seekers: An Individual Participant Data Meta-Analysis
    (BMJ Ment Health, 2023-07-31) Eirini Karyotaki, Marit Sijbrandij, Marianna Purgato, Lakin Daniel, Leku Marx Ronald, Corrado Barbui
    Refugees and asylum seekers are at high risk of mental disorders due to various stressors before, during and after forceful displacement. The WHO Self-Help Plus (SH+) intervention was developed to manage psychological distress and a broad range of mental health symptoms in vulnerable populations. This study aimed to examine the effects and moderators of SH+ compared with Enhanced Care as Usual (ECAU) in reducing depressive symptoms among refugees and asylum seekers
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    Prevention and Promotion Effects of Self Help Plus: Secondary Analysis of Cluster Randomised Controlled Trial Data among South Sudanese Refugee Women in Uganda
    (BMJ open, 2023-09-12) Augustinavicius Jura, Purgato Marianna, Marx .Ronald Leku, Kenneth Carswell, 6 Daniel Lakin, Eirini Karyotaki, Corrado Barbui
    Evidence-based and scalable prevention and promotion focused mental health and psychosocial support interventions are needed for conflict-affected populations in humanitarian settings. This study retrospectively assessed whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being postintervention among South Sudanese refugee women in Uganda.
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    Child pedestrian crossing behaviour and associated risk factors in school zones: a video-based observational study in Kampala, Uganda
    (BMJ Publishing Group Ltd, 2024-05) Osuret, Jimmy; Van Niekerk, Ashley; Kobusingye, Olive; Atuyambe, Lynn; Nankabirwa, Victoria
    Abstract BackgroundPedestrian crashes, often occurring while road crossing and associated with crossing behaviour, make up 34.8% of road casualties in Uganda. This study determined crossing behaviour and associated factors among child pedestrians around primary schools in Kampala, Uganda.MethodsWe conducted a cross-sectional study in 2022 among 2100 primary school children. Data on their crossing behaviour were collected using video recordings from cameras staged at the crossing points of 21 schools. We estimated prevalence ratios (PR) with their corresponding 95% CIs using a modified Poisson regression model for the association between unsafe behaviour and the predictors.ResultsThe prevalence for each of 5 unsafe child pedestrian behaviour was 206 (25.8%) for crossing outside the crosswalk, 415 (19.8%) for failing to wait at the kerb, 238 (11.3%) for failing to look for vehicles, 361 (17.2%) for running and 235 (13%) for crossing between vehicles. There was a higher likelihood of crossing outside the crosswalk when an obstacle was present (adjusted PR (aPR) 1.8; 95% CI 1.40 to 2.27) and when children crossed alone (aPR 1.5; 95% CI 1.13 to 2.06). Children who crossed without a traffic warden (aPR 2; 95% CI 1.40 to 2.37) had a significantly higher prevalence of failing to wait at a kerb.ConclusionThese findings reveal the interaction between child pedestrians, vehicles and the environment at crossings. Some factors associated with unsafe child pedestrian behaviour were the presence of an obstacle, crossing alone and the absence of a traffic warden. These findings can help researchers and practitioners understand child pedestrian crossing behaviour, highlighting the need to prioritise targeted safety measures.
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    Stakeholder expectations, inter-organizational coordination and procurement practices among humanitarian organizations
    (Journal of Business and Socio-economic Development, 2023) Mutebi, Henry; Aryatwijuka, Wilbroad; Rukundo, Aloysious; Twongyirwe, Ronald; Tumwebembeire, Naster; Tugiramasiko, Miriam
    This paper aims to examine the interconnectedness between stakeholder expectations (SE), interorganizational coordination (IOC) and procurement practices within humanitarian organizations (HOs) based in Uganda. Design/methodology/approach – Employing a quantitative cross-sectional design, data were gathered from 43 HOs and analyzed using SmartPLS 4.0.8.3. Variance-based structural equation models (VB-SEMs) were employed to examine both direct and indirect effects. Findings – The findings show a significantly positive relationship between SE, IOC and procurement practices. Additionally, the mediating role of IOC in the relationship between SE and procurement practices is evident. Research limitations/implications – While this study offers insights into procurement practices in HOs, the use of a quantitative approach might limit capturing dynamic changes over time. Future research could benefit from a nuanced approach involving interviews and longitudinal studies to uncover incremental changes. Practical implications – During relief management, HOs need to understand their SE through information sharing and capacity building. This understanding can aid in selecting procurement practices that align with SE and ensure the delivery of relief. Originality/value – Leveraging stakeholder theory, this research contributes to the understanding of how SE and IOC influence the adoption of procurement practices in HOs during relief delivery.
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    Cost of digital technologies and family-observed DOT for a shorter MDR-TB regimen: a modelling study in Ethiopia, India and Uganda
    (BioMed Central Ltd, 2023-11) Rosu, Laura; Madan, Jason; Bronson, Gay; Nidoi, Jasper; Tefera, Mamo G; Malaisamy, Muniyandi; Squire, Bertel S; Worrall, Eve
    Abstract Abstract Background In 2017, the WHO recommended the use of digital technologies, such as medication monitors and video observed treatment (VOT), for directly observed treatment (DOT) of drug-susceptible TB. The WHO’s 2020 guidelines extended these recommendations to multidrug-resistant tuberculosis (MDR-TB), based on low evidence. The impact of COVID on health systems and patients underscored the need to use digital technologies in the management of MDR-TB. Methods A decision-tree model was developed to explore the costs of several potential DOT alternatives: VOT, 99DOTS (Directly-observed Treatment, Short-course) and family-observed DOT. Assuming a 9-month, all-oral regimen (as evaluated within the STREAM trial), we constructed base-case cost models for the standard-of-care DOTs in Ethiopia, India, and Uganda, as well as for the three alternative DOT approaches. The models were populated with STREAM Stage 2 clinical trial outcome and cost data, supplemented with market prices data for the digital DOT strategies. Sensitivity analyses were conducted on key parameters. Results Modelling suggested that the standard-of-care DOT approach is the most expensive DOT strategy from a societal perspective in all three countries evaluated (Ethiopia, India, Uganda), with considerable direct- and indirect-costs incurred by patients. The second most expensive DOT approach is VOT, with high health-system costs, largely caused by up-front technology expenditure. Each of VOT, 99DOTS and family-observed DOT would reduce by more than 90% patients’ direct and indirect costs compared to standard of care DOT. Results were robust to the sensitivity analyses. Conclusions While data on the costs and efficacy of alternative DOT approaches in the context of shorter MDR-TB treatment is limited, our modelling suggests alternative DOT approaches can significantly reduce patient costs in all three countries. Health system costs are higher for VOT and lower for 99DOTS and family-observed therapy when compared to standard of care DOT, as low smartphone penetration and internet availability requires the VOT health system to fund the cost of making them available to patients.